Browsing by Author "Pankow, James S."

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Cadmium, obesity, and education, and the 10-year incidence of hearing impairment: The beaver dam offspring study
(1970-01-01)
Dalton, Dayna S.
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Schubert, Carla R.
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Pinto, Alex
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Fischer, Mary E.
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Huang, Guan-Hua
Objectives/Hypothesis To determine the 10-year incidence of hearing impairment (HI) and associated risk factors in the Beaver Dam Offspring Study (BOSS; 2004-present), a large middle-aged cohort followed for 10 years. Study Design Prospective cohort study. Methods Hearing thresholds were measured at baseline (2005-2008) and 5- (2010-2013) and 10-year (2015-2017) follow-up examinations. HI was defined as a pure-tone average >25 dB HL in either ear. BOSS participants free of HI at baseline with at least one follow-up examination (N = 2,065) were included. Potential risk factors evaluated included cardiovascular measures, health history, lifestyle factors, inflammatory markers, vitamins D and B12, lead, and cadmium. Results Participants were 21 to 79 years (mean age = 47.9 years) at baseline. The 10-year cumulative HI incidence was 17.4% (95% confidence interval [CI]: 15.7-19.2) and was twice as likely in men (24.4%, 95% CI: 21.5-27.7) than in women (12.2%, 95% CI: 10.3-14.3). In a multivariable adjusted model, age (hazard ratio [HR] = 1.48, 95% CI: 1.38-1.59, per 5 years), male sex (HR = 2.47, 95% CI: 1.91-3.18), less than a college education (HR = 1.35, 95% CI: 1.02-1.79), body mass index (HR = 1.03, 95% CI: 1.01-1.05, per kg/m(2)), and higher cadmium levels (HR = 1.42, 95% CI: 1.05-1.92, quintile 5 vs. quintiles 1-4) were associated with the 10-year cumulative incidence of HI. There was no association between high lead levels, vitamins D or B12, and 10-year incidence of HI. Conclusions In addition to age and sex, obesity, education, and blood cadmium levels were associated with increased incidence of HI. These prospective results add to evidence that age-related HI is a multifactorial preventable disorder. Level of Evidence 2b Laryngoscope, 2019
Carotid atherosclerosis and cognitive function in midlife: The beaver dam offspring study
(2011-11-01)
Zhong, Wenjun
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Cruickshanks, Karen J.
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Huang, Guan-Hua
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Klein, Barbara E. K.
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Klein, Ronald
Background: Atherosclerosis may be associated with cognitive function; however the studies are few, especially among midlife adults. Methods: Participants in the beaver dam offspring study who had cognitive test data and gradable carotid artery ultrasound scans were included (n = 2794, mean age: 49 years). Atherosclerosis was measured by carotid intima-media thickness (IMT) and the presence of plaque. Cognitive function was measured by the trail making test (TMT), grooved pegboard test (GPT) and mini-mental state examination (MMSE). Generalized cognitive function was defined by a summary score calculated from the TMT and GPT. Linear regression was used to evaluate the associations between carotid atherosclerosis and cognitive function tests. Results: Larger IMT was associated with lower GPT, MMSE and the summary score adjusting for multiple factors, the coefficients were: 13.8s (p < 0.0001), -0.6 (p = 0.007), and 0.47 (p = 0.01), respectively for 1 mm increase in IMT. Plaque scores were significantly associated with TMT-B, GPT, MMSE, and the summary score adjusting for age, sex and education. The associations remained statistically significant after further adjustments except for the association with TMT-B, which was attenuated and no longer significant. Conclusions: Our results show the significant associations between markers of carotid atherosclerosis and cognitive function in a cohort of persons aged 21-84 years. Longitudinal studies are needed to further examine these associations. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
Factors Related to Fungiform Papillae Density: The Beaver Dam Offspring Study
(2013-10-01)
Fischer, Mary E.
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Cruickshanks, Karen J.
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Schubert, Carla R.
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Pinto, Alex
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Klein, Ronald
The distribution of fungiform papillae density and associated factors were examined in the Beaver Dam Offspring Study. Data were from 2371 participants (mean age 48.8 years, range 2184 years) with 1108 males and 1263 females. Fungiform papillae were highlighted with blue food coloring and the number of fungiform papillae within a standard 6-mm circle was counted. Whole mouth suprathreshold taste intensity was measured. The mean fungiform papillae density was 103.5 papillae/cm(2) (range 0212.2 papillae/cm(2)). For each 5-year increase in age, the mean fungiform papillae density was 2.8 papillae/cm(2) lower and the mean density for males was 10.2 papillae/cm(2) lower than for females. Smokers had significantly lower mean densities (former smokers: 5.1 papillae/cm(2); current smokers: 9.3 papillae/cm(2)) than nonsmokers, and heavy alcohol drinkers had a mean density that was 4.7 papillae/cm(2) lower than nonheavy drinkers. Solvent exposure was related to a significantly higher density (6.8 papillae/cm(2)). The heritability estimate for fungiform papillae density was 40.2%. Propylthiouracil taster status, TAS2R38 haplotype, and perceived taste intensity were not related to density. In summary, wide variability in fungiform papillae density was observed and a number of related factors were found including the modifiable factors of smoking and alcohol consumption.
Familial Aggregation of Age-Related Hearing Loss in an Epidemiological Study of Older Adults
(2009-12-01)
Raynor, Laura A.
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Pankow, James S.
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Miller, Michael B.
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Huang, Guan-Hua
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Dalton, Dayna
Purpose: To estimate the genetic contributions to presbycusis. Method: Presbycusis was assessed by audiometric measurements at 3 waves of the population-based Epidemiology of Hearing Loss Study (EHLS). Measurements from the most recent hearing examination were used, at which time the subjects (3,510 participants from the EHLS study) were between 48 and 100 years of age. Heritability of presbycusis was estimated using maximum likelihood methods in 973 biological relative pairs from 376 families. Familial aggregation was also evaluated by tetrachoric correlations, odds ratios, and lambda statistics in 594 sibling pairs from 373 sibships. Results: The prevalence of presbycusis conformed to previous research, increasing with age and male sex. Heritability estimates for presbycusis adjusted for age, sex, education level, and exposure to work noise exceeded 50%, and siblings of an affected relative were at 30% higher risk. When stratified by sex, estimates of familial aggregation were higher in women than men. Conclusions: There is evidence that genetic factors contribute to age-related hearing loss in this population-based sample. The familial aggregation is stronger in women than in men.
Familial Aggregation of Olfactory Impairment and Odor Identification in Older Adults
(2010-08-01)
Raynor, Laura A.
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Pankow, James S.
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Cruickshanks, Karen J.
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Schubert, Carla R.
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Miller, Michael B.
Objectives/Hypothesis: The objective of this analysis was to estimate the genetic contributions to olfactory impairment. Study Design: Population based. Methods: Olfactory impairment was measured using the San Diego Odor Identification Test at the 5-year follow-up examination for the population-based Epidemiology of Hearing Loss study. Subjects were classified as impaired if they correctly identified fewer than six out of eight odorants. To reduce confounding by age, analysis was restricted to subjects who were 60 to 79 years of age. Familial aggregation was evaluated by heritability estimates, tetrachoric correlations, and odds ratios in 207 sibling pairs from 135 sibships. Results: The prevalence of olfactory impairment was 20.2% overall and was higher in men. After adjustment for sex, age, and smoking, heritability of olfactory impairment was moderate (h(2) = 0.55), although not statistically significantly different from 0 (P = .09). By contrast, the adjusted heritability estimate for bubble gum, one of the individual odorants, was significant (h(2) = 0.51; P = .01). Conclusions: Genetic factors might contribute to general olfactory impairment in older adults, but the strength of familial aggregation differs for individual odorants, a finding consistent with prior research.
Generational Differences in the Prevalence of Hearing Impairment in Older Adults
(2010-01-15)
Zhan, Weihai
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Cruickshanks, Karen J.
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Klein, Barbara E. K.
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Klein, Ronald
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Huang, Guan-Hua
There were significant changes in health and lifestyle throughout the 20th century which may have changed temporal patterns of hearing impairment in adults. In this study, the authors aimed to assess the effect of birth cohort on the prevalence of hearing impairment in an adult population aged 45-94 years, using data collected between 1993 and 2008 from 3 cycles of the Epidemiology of Hearing Loss Study (n = 3,753; ages 48-92 years at baseline) and a sample of participants from the Beaver Dam Offspring Study (n = 2,173; ages >= 45 years). Hearing impairment was defined as a pure-tone average of thresholds at 0.5, 1, 2, and 4 kHz greater than 25-dB HL [hearing level]. Descriptive analysis, generalized additive models, and alternating logistic regression models were used to examine the birth cohort effect. Controlling for age, with every 5-year increase in birth year, the odds of having hearing impairment were 13% lower in men (odds ratio = 0.87, 95% confidence interval: 0.83, 0.92) and 6% lower in women (odds ratio = 0.94, 95% confidence interval: 0.89, 0.98). These results suggest that 1) older adults may be retaining good hearing longer than previous generations and 2) modifiable factors contribute to hearing impairment in adults.
Measuring Taste Impairment in Epidemiologic Studies The Beaver Dam Offspring Study
(2008-10-01)
Cruickshanks, Karen J.
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Schubert, Carla R.
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Snyder, Derek J.
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Bartoshuk, Linda M.
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Acher, Charles W.
Meta-analysis of Dense Genecentric Association Studies Reveals Common and Uncommon Variants Associated with Height
(2011-01-07)
Lanktree, Matthew B.
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Guo, Yiran
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Murtaza, Muhammed
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Glessner, Joseph T.
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Bailey, Swneke D.
Height is a classic complex trait with common variants in a growing list of genes known to contribute to the phenotype. Using a genecentric genotyping array targeted toward cardiovascular-related loci, comprising 49,320 SNPs across approximately 2000 loci, we evaluated the association of common and uncommon SNPs with adult height in 114,223 individuals from 47 studies and six ethnicities. A total of 64 loci contained a SNP associated with height at array-wide significance (p < 2.4 x 10(-6)), with 42 loci surpassing the conventional genome-wide significance threshold (p < 5 x 10(-8)). Common variants with minor allele frequencies greater than 5% were observed to be associated with height in 37 previously reported loci. In individuals of European ancestry, uncommon SNPs in IL11 and SMAD3, which would not be genotyped with the use of standard genome-wide genotyping arrays, were strongly associated with height (p < 3 x 10(-11)). Conditional analysis within associated regions revealed five additional variants associated with height independent of lead SNPs within the locus, suggesting allelic heterogeneity. Although underpowered to replicate findings from individuals of European ancestry, the direction of effect of associated variants was largely consistent in African American, South Asian, and Hispanic populations. Overall, we show that dense coverage of genes for uncommon SNPs, coupled with large-scale meta-analysis, can successfully identify additional variants associated with a common complex trait.
Modifiable determinants of hearing impairment in adults
(2011-10-01)
Zhan, Weihai
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Cruickshanks, Karen J.
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Klein, Barbara E. K.
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Klein, Ronald
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Huang, Guan-Hua
Objective. To identify factors contributing to the declining prevalence of hearing impairment in more recent generations. Methods. We used data on hearing thresholds and potential risk factors of hearing impairment collected from studies in Beaver Dam, Wisconsin, the Epidemiology of Hearing Loss Study (1993-1995, n=3753; 1998-2000, n = 2800 and 2003-2005, n=2395), the concurrent Beaver Dam Eye Study on the same cohort, and a subgroup (n = 2173) of the Beaver Dam Offspring Study (2005-2008). Results. Educational attainment significantly reduced the odds ratio (OR) of the birth cohort effect on hearing impairment from 0.90 to 0.93, while a history of ear infection had a reverse effect on the decreasing trend (significantly changing the OR from 0.93 to 0.94). Occupational noise exposure, smoking, and a history of cardiovascular disease, while associated with hearing impairment, did not attenuate the cohort effect. The cohort effect remained significant after known risk factors were adjusted (OR = 0.93; 95% confidence interval, 0.89-0.97). Conclusion. These data provide strong evidence that environmental, lifestyle, or other modifiable factors contribute to the etiology of hearing impairment and add support to the idea that hearing impairment in adults may be prevented or delayed. (C) 2011 Elsevier Inc. All rights reserved.
Olfactory Impairment in Adults The Beaver Dam Experience
(2009)
Schubert, Carla R.
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Cruickshanks, Karen J.
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Murphy, Claire
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Huang, Guan-Hua
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Klein, Barbara E. K.
Olfactory function maybe important for environmental and nutritional safety and enjoyment. Population-based epidemiological studies of olfaction are needed to understand the magnitude of the health burden, identify modifiable risk factors, and develop and test prevention and treatment strategies for olfactory impairment. However, measuring olfaction in large studies is challenging, requiring repeatable, efficient methods that can measure change over time. Two large cohort studies, the Epidemiology of Hearing Loss Study (EHLS) and the Beaver Dam Offspring Study (BOSS), included olfactory testing. In both studies, the San Diego Odor Identification Test (SDOIT) was used to measure olfaction. Subjects were asked to identify eight common household odors (such as coffee and chocolate). Olfactory impairment was defined as correctly identifying fewer than six out of eight odorants after two trials. The EHLS participants were age 53-95 years at the time of the first measurement (1998-2000), and participants in the BOSS were age 21-84 years. The prevalence of olfactory impairment in the EHLS was 25% overall, more common in men than women, and increased with age. Five years later olfaction was measured a second time and the majority (84%) of the EHLS participants were classified the same. Among those with impairment at the base line nearly one-third (31%) improved to unimpaired. This heterogeneity in olfactory impairment has unique implications for data analyses and predicting outcomes and associations. Preliminary data from the BOSS suggest the prevalence of olfactory impairment may be lower in younger generations. All these factors point to a continuing need for epidemiological studies of olfaction.
Olfactory Impairment in Adults: The Epidemiology of Hearing Loss Study and the Beaver Dam Offspring Study
(2008-10-01)
Schubert, Carla R.
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Cruickshanks, Karen J.
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Murphy, Claire
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Acher, Charles W.
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Huang, Guan-Hua
Olfactory Impairment in an Adult Population: The Beaver Dam Offspring Study
(2012-05-01)
Schubert, Carla R.
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Cruickshanks, Karen J.
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Fischer, Mary E.
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Huang, Guan-Hua
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Klein, Barbara E. K.
The objective of this study was to determine the prevalence of olfactory impairment and associated risk factors and the effects of olfactory impairment on dietary choices and quality of life. Odor identification was measured in 2838 participants aged 21-84 years (mean 49 years) in the Beaver Dam Offspring Study. The overall prevalence of olfactory impairment was 3.8%, increased with age (from 0.6% in those < 35 years to 13.9% among those >= 65 years) and was more common in men than women. In a multivariate model age (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.33, 1.64 for every 5-year increase), nasal polyps or deviated septum (OR = 2.69, 95% CI = 1.62, 4.48), ankle-brachial index < 0.9 (OR = 3.62, 95% CI = 1.45, 9.01), and smoking (women only) (OR = 2.43, 95% CI = 1.19, 4.98 ever smoked vs. never) were associated with an increased odds of olfactory impairment, whereas higher household income, >=$50 000 versus <$50 000 per year, was associated with a decreased odds of olfactory impairment (OR = 0.48, 95% CI = 0.31, 0.73). Participants with olfactory impairment were less likely to report that food tasted as good as it used to, or that they experienced food flavors the same. There was no association between olfactory impairment and general health-related quality of life, depressive symptoms, or dietary choices. The prevalence of olfactory impairment was low in this largely middle-aged cohort, and some factors associated with olfactory impairment are potentially modifiable.
Prevalence of Olfactory Impairment in Adults Across the Life Span: The Beaver Dam Offspring Study
(2009-09-01)
Schubert, Carla R.
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Cruickshanks, Karen J.
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Krantz, Elizabeth M.
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Huang, Guan-Hua
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Klein, Barbara E. K.
Pulse-Wave Velocity and Cardiovascular Risk Factors in the Beaver Dam Offspring Study (BOSS) Population
(2009-03-17)
Zhong, Wenjun
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Cruickshanks, Karen J.
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Schubert, Carla
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Javier Nieto, F.
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Pankow, James S.
Relationships of Retinal Arteriolar and Venular Diameters with Carotid Intima-Media Thickness: The Beaver Dam Offspring Study
(2009-03-17)
Godreau, Ayleen
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Klein, Ronald
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Lee, Kristine
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Klein, Barbara E. K.
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Schubert, Carla
Sensorineural Impairments, Cardiovascular Risk Factors, and 10-Year Incidence of Cognitive Impairment and Decline in Midlife: The Beaver Dam Offspring Study
(2019-11-01)
Schubert, Carla R.
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Cruickshanks, Karen J.
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Fischer, Mary E.
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Pinto, A. Alex
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Chen, Yanjun
Background: Sensorineural impairments and cardiovascular risk factors (CVRF) and disease (CVD) in midlife may be important predictors of future cognitive health, but longitudinal studies that include multiple sensorineural measures in middle-aged adults are lacking. Methods: Hearing, vision, and olfaction, and CVRF and CVD were measured at the Beaver Dam Offspring Study baseline (2005-2008) examination. The Mini-Mental State Examination and Trail Making Tests A and B were administered at all phases and additional cognitive function measures were obtained at 5 (2010-2013) and 10 years (2015-2017). Cox proportional hazards models were used to evaluate associations between baseline sensorineural impairments, CVRF, CVD, and 10-year cumulative incidence of cognitive impairment and decline. Results: There were 2,556 participants (22-84 years) without cognitive impairment at baseline and data from at least one follow-up. In a multivariable model including age, sex, education, and head injury, visual impairment (hazard ratio = 2.59, 95% confidence interval = 1.34, 5.02), olfactory impairment (hazard ratio = 3.18, 95% confidence interval = 1.53, 6.59), CVD (hazard ratio = 2.37, 95% confidence interval = 1.24, 4.52), and not consuming alcohol in the past year (hazard ratio = 2.21, 95% confidence interval = 1.16, 4.19) were associated with the 10-year cumulative incidence of cognitive impairment. Current smoking and diabetes were associated with increased risk, and exercise with decreased risk, of 10-year decline in cognitive function. Conclusions: Visual and olfactory impairments, CVRF, and CVD were associated with the 10-year cumulative incidence of cognitive impairment and decline in middle-aged adults. Identifying modifiable factors associated with cognitive decline and impairment in midlife may provide opportunities for prevention or treatment and improve cognitive health later in life.
Taste Intensity in the Beaver Dam Offspring Study
(2013-06-01)
Fischer, Mary E.
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Cruickshanks, Karen J.
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Schubert, Carla R.
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Pinto, Alex
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Klein, Barbara E. K.
Objectives/Hypothesis: To determine the distribution of the perceived intensity of salt, sweet, sour, and bitter in a large population and to investigate factors associated with perceived taste intensity. Study Design: Cross-sectional population. Methods: Subjects (n = 2,374; mean age, 48.8 years) were participants in the Beaver Dam Offspring Study examined during 2005 to 2008. Perceived taste intensity was measured using paper disks and a general labeled magnitude scale. Multiple linear regression was performed. Results: Mean intensity ratings were: salt = 27.2 (standard deviation [SD] = 18.5), sweet = 0.4 (SD = 15.0), sour = 35.7 (SD = 21.4), and bitter = 49.6 (SD 23.3). Females and those with less than a college degree education rated tastes stronger. With adjustment for age, sex, and education, stronger perceived sour and bitter intensities were related to current smoking (sour: B = 2.8, 95% confidence interval [CI], 0.4 to 5.2; bitter: B = 2.8, 95% CI, 0.3 to 5.4) and lipid-lowering medications (sour: B = 5.1, 95% CI, 2.5 to 7.6; bitter: B = 3.2, 95% CI, 0.6 to 5.8). Alcohol consumption in the past year was related to weaker salt (B = -2.8, 95% CI, -5.3 to -0.3) and sweet intensity ratings (B = -2.3, 95% CI, -4.3 to -0.3), whereas olfactory impairment was associated with higher sweet ratings (B = 4.7, 95% CI, 1.4 to 7.9). Conclusions: Perceived intensities were strongest for bitter and weakest for sweet. Sex and education were associated with each taste, whereas age did not demonstrate a consistent relationship. Associations with other factors differed by tast-ants, with current smoking and alcohol consumption being related to some tastes.
The Association of Taste with Change in Adiposity-Related Health Measures
(2014-08-01)
Fischer, Mary E.
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Cruickshanks, Karen J.
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Schubert, Carla R.
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Pinto, Alex
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Huang, Guan-Hua
The relationship between taste-intensity patterns and 5-year change in adiposity-related health measures was determined. Participants were members of the Beaver Dam Offspring Study, a study of the adult children of participants in the population-based Epidemiology of Hearing Loss Study. There were 1,918 participants (mean baseline age=48.8 years; range=22 to 84 years) with baseline taste (2005 to 2008) and follow-up (2010 to 2013) data Outcomes included 5-year change in body mass index, waist circumference, blood pressure, non high-density lipoprotein cholesterol, and glycosylated hemoglobin A1c, and hedonic ratings of specific foods. Cluster analysis with Ward\'s minimum variance method identified the following 5 patterns of the suprathreshold taste intensities of salt, sweet, sour, and bitter: salt and sweet intensities slightly above population averages, average sour and bitter intensities; salt, sour, and bitter intensities above population average, average sweet intensity; salt, sour, and bitter intensities above population average, sweet intensity substantially above average; all intensities below population averages; and all intensities close to population average. The General Linear Model procedure was used for testing cluster differences in the outcomes. With covariate adjustment, the group with all intensities close to population averages had a significantly lower average increase in body mass index compared with the group with above-average intensities for salt, sour, and bitter (+0.4 vs +0.9), and in glycosylated hemoglobin A1 c compared with the group with above-average intensities for all tastes (+0.20% vs +0.34%). Clusters differed in the hedonics of foods representing sweetness and saltiness. The study\'s findings provide evidence that perceived taste intensity might be related to changes in adiposity-related health.
The Associations between 6-n-Propylthiouracil (PROP) Intensity and Taste Intensities Differ by TAS2R38 Haplotype
(2014-01-01)
Fischer, Mary E.
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Cruickshanks, Karen J.
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Pankow, James S.
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Pankratz, Nathan
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Schubert, Carla R.
Background/Aims: The influence of TAS2R38 haplotype on the relationship between the perceived intensity of propylthiouracil (PROP) and the basic tastes of salt, sweet, sour, and bitter (quinine) was evaluated in the Beaver Dam Offspring Study. Methods: Genotyping was performed on 1,670 participants aged >= 45 years (mean age = 54.4; range = 45-84), and supra-threshold taste intensity was measured using filter paper disks and a general labeled magnitude scale (0-100). Results: Among those with taste intensity data and the PAV or AVI haplotype (n = 1,258), the mean perceived intensity of PROP was 37.3 (SD = 30.0), but it varied significantly (p < 0.0001) by diplotype (PAV/PAV = 60.1; PAV/AVI = 46.5; AVI/AVI = 14.4). PROP intensity was correlated with the basic taste intensities (salt: r = 0.22; sweet: r = 0.25; sour: r = 0.21; quinine bitterness: r = 0.38; p < 0.001 for all tastes); however, a significant effect modification of the PROP-taste intensity relationships by TAS2R38 diplotype was observed. There was a stronger association between PROP and each of the basic tastes in the PAV/PAV diplotype group than in the other groups. Conclusions: Directly measuring the perceived intensity of the 4 tastes, rather than using PROP intensity as an indicator of taste responsiveness, is recommended for studies of taste perception. (C) 2015 S. Karger AG, Basel
The Prevalence of Age-Related Macular Degeneration and Associated Risk Factors
(2010-06-01)
Klein, Ronald
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Cruickshanks, Karen J.
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Nash, Scott D.
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Krantz, Elizabeth M.
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Javier Nieto, F.
Objectives: To determine the prevalence of age-related macular degeneration (AMD) and to examine how retinal drusen, retinal pigmentary abnormalities, and early AMD are related to age, sex, and other risk factors. Participants: A total of 2810 people aged 21 to 84 years participating in the Beaver Dam Offspring Study. Methods: The presence and severity of various characteristics of drusen and other lesions typical of AMD were determined by grading digital color fundus images using the Wisconsin Age-Related Maculopathy Grading System. Results: Early AMD was present in 3.4% of the cohort and varied from 2.4% in those aged 21 to 34 years to 9.8% in those aged 65 years or older. In a multivariable model (expressed as odds ratio; 95% confidence interval), age (per 5 years of age, 1.22; 1.09-1.36), being male (1.65; 1.01-2.69), more pack-years of cigarettes smoked (1-10 vs 0, 1.31; 0.75-2.29; >= 11 vs 0, 1.67; 1.03-2.73), higher serum high-density lipoprotein cholesterol level (per 5 mg/dL, 0.91; 0.83-0.998), and hearing impairment (2.28; 1.41-3.71) were associated with early AMD. There were no associations of blood pressure level, body mass index, physical activity level, history of heavy drinking, white blood cell count, hematocrit level, platelet count, serum total cholesterol level, or carotid intimal-medial thickness with early AMD. Conclusions: These data indicate that early AMD is infrequent before age 55 years but increases with age thereafter. Early AMD is related to modifiable risk factors, eg, smoking and serum high-density lipoprotein cholesterol level.